Stem cell therapy has drawn a lot of interest lately. This therapy has shown promise in treatments of a large number of life- threatening and/or debilitating disorders that are genetic in nature. Stem cells are like base cells. They are like clay that can be molded into any desired shape. These master cells are multi potent and if given optimum conditions, they can be induced to grow into any one of the various types of differentiated cells in our body; for example Brain or liver cells. Thus these special cells have two important attributes: 1. They can renew themselves by cell division even after relatively long periods of inaction. 2. Once they have divided, each daughter cell can either remain as a stem cell, retaining all its pluripotency or it can differentiate into any one of the different organ types in the body. Stem cells also exist in various tissue systems to serve repair functions.

Typically stem cells are divided into adult stem cells and embryonic stem cells. Embryonic stem cells are derived from the Blastocyst stage of Embryos. Embryonic stem cells can generally give rise to almost all the different cell types in the human body. Adult stem cells on the other hand, generally give rise only to all the different cells of the particular tissue from which they are derived. What does this mean? In simple terms, Hematopoetic Stem cells derived from bone marrow can give rise to all the different types of blood cells but not to cells of a very different organ system such as neurons of the brain. So in a sense they are of limited capacity. In 2006, researchers made another breakthrough by identifying conditions that would allow some specialized adult cells to be “reprogrammed” genetically to assume a stem cell-like state. This new type of stem cell is called induced pluripotent stem cells (iPSCs).

The unique properties of these cells have given rise to a new field of research known as Regenerative or Reparative medicine. This field is defined as the field of medicine dedicated to the use of stem cells for treatment of diseases by inducing them to differentiate into the tissue type that has been destroyed. A large number of Genetic diseases are now currently being treated by the use of Regenerative therapy. Acute Lymphoblastic Leukemia, Common Variable Immune Deficiency, Hunter’s Syndrome, Thalassemia, and Tay Sach Disease to name just a few are being treated using these therapies.

So What Is Cord Blood?

Cord Blood

After the birth of a baby the umbilical cord that forms the connection between the mother and child when still in the womb is cut. Even so, some blood remains in the blood vessels of the placenta and the attached umbilical cord. The baby now no longer has need for this blood which is called placental blood or umbilical cord blood: “cord blood” for short.

Cord blood contains all the normal elements of blood – red blood cells, white blood cells, platelets and plasma. But it is also rich in hematopoietic (blood-forming) stem cells, similar to those found in bone marrow. Cord blood, therefore, is being used increasingly on an experimental basis as a source of stem cells, as an alternative to bone marrow. Most cord blood transplants have been done to treat diseases of the blood and immune system. It has also been used to restore the functional deficiencies of several genetic metabolic diseases. Scientists are investigating the possibility that stem cells in cord blood may be able to replace cells of other tissues such as nerve or heart cells. Whether cord blood can be used to treat other kinds of diseases will be learned from this research.

In this context, I would like to quote from a 2007 document released by the American Diabetes Association with respect to a clinical trial carried out using Cord Blood cells. “In a small pilot study, transfusion of stored, autologous (i.e. the person’s own), umbilical cord blood into a group of children newly diagnosed with type 1 diabetes appears to have reduced their disease severity, possibly re-setting the immune system and slowing the destruction of their insulin-producing cells, according to a report presented at the American Diabetes Association’s 67th Annual Scientific Sessions.” “After only six months, it is too early to tell how long the children will benefit from this therapy, but early signs indicate that it may have helped enhance blood glucose control and management,” said Michael J. Haller, MD, Assistant Professor of Pediatric Endocrinology at the University of Florida College of Medicine and lead author of the study, “but more important than the potential benefit in these children, this first use of cord blood in diabetes will help us focus on what it is in the cord blood that yielded the benefit,” he said. “We then hope to isolate and grow that cell type to develop therapies for a larger pool of people, not just those who have stored cord blood.” He discussed how such a cellular therapy might be one component of a future immune-modulating “cocktail.” This I think underlines the basis of all stem cell related therapy.

In a study in rats, it was shown that, Intravenous injections of cells from human umbilical cord blood improved the neurological and motor function of the rats that were recovering from severe traumatic brain injury. This was demonstrated by researchers at Henry Ford Health Sciences Center (HFHSC), Detroit, and the University of South Florida (USF), Tampa. If this is indeed true, then we will have hit upon a relatively easily obtained source of stem cells that can be safely collected and screened and stored for future use.

What is even better is that unlike bone marrow or organ transplants an exact match of cord blood antigens is not necessary.

What Is Cord Blood Matching?

HLA matching

Whenever any type of transplantation is carried out, organ transplants or blood transfusions, it is necessary to “match” markers that are known as antigens of the donor and the recipients. What are these antigens? They are proteinaceous ‘tags’ or molecules that are present on surfaces of cells and tissue of our body. These tags define our uniqueness. The moment a foreign ‘tag’ enters our system; our body senses it and we mount an immunological response to the same. This is known as rejection. So if a person undergoing a kidney transplant for example, receives a kidney whose tissue has antigenic tags that are very different from those of his own kidney, his body will attack the transplanted kidney and he will have what is known as a Graft Rejection. Similar is the case with blood transfusion and hence only after determining the relevant blood group can the transfusion be successfully accomplished. Rejection reactions are extremely strong reactions and can be fatal. Thus, the advantages of not requiring a complete antigenic match while using cord blood for cure become evident. In a cord blood transfer, the antigens that are matched are known as HLA (Human Lymphocyte Antigens); the same ones that are matched during organ transplants. Now there are a large number of different HLAs found in our tissues so not all of them are matched for reasons of practicality. Out of all of these, 6 important antigenic clusters that are found to be of prime importance in rejection processes have been identified. These major groups are, HLA A, B and DRB1. Complete matches between the donor and the recipient would mean 2 pairs each Of HLA A,B and DRB1; a total of six. This complete match is known as a 6/6 match or a 6/6 HLA match. Sometimes an additional set of antigens are used for better matching. These are, HLA C and DQ. Thus, complete matching of these additional markers yield a total of 10 points. So, one may have a 6/10 match or a 10/10 match or a 5/10 match. Generally, the first 3 antigens are used and a 6/6 match is considered perfect. While a 5/6 match works best, a large number of successful procedures have been carried out using just a 3/6 match that is only 3 out of the stipulated 6 markers match! That is incredible and it exponentially increases chances of success in finding a donor. Today almost 70 different genetic disorderscan be treated using Cord Blood.

Cord Blood Banking In India

The awareness about cord blood banking has seen a spurt in India, with a large number of companies entering the fray in order to set up such blood banks. Cord stem cell banks process leftover umbilical cord blood from the placenta and umbilical cord after the baby is delivered, and preserves by freezing them in liquid nitrogen at a temperature of -195 degrees celsius. Umbilical cord blood banks can be divided into two categories: private and public. In private banks, one can keep the umbilical cord for two decades, which can be claimed by the family or the patient. For example, At Lifecell, one such private bank, each client has to incur Rs 27,000 ($621 USD) as enrollment and processing fees and will be charged Rs 2,900 ($66 USD) every year as storage cost. For one-time payment, the cost comes to Rs 59,900 ($1,377 USD). The donor cannot stake claim from public banks. Similarly, The Apollo Group of Hospitals has also recently signed a memorandum of understanding with the American blood bank Histostem Inc to offer stem cell therapy to patients from South Asia. As part of the deal, Histostem India will train doctors and nurses at Apollo for stem cell treatment protocols and develop new treatment protocols with relevant regulatory approval. (Source). For a list of cord blood banks in India, please refer to this link.

The costs are still prohibitively high and out of reach of most middle class families in India. There are some incentives available through the banking sector in the form of loans, for example, StemOne Biologicals Private Limited formerly Cord Life Biotech had a strategic alliance with the bank ICICI. Cord blood clients could obtain personal loans from ICICI to cover the cost of cord blood banking. According to Stem Cells Research Forum of India (SCRFI), India’s stem cell market is growing at a rate of 15% per annum and is estimated to hit US $ 40 Million by the year 2010. As of 2008, StemOne Biologicals Pvt Ltd. is the only company in India offering the entire spectrum of stem cell related services: In addition to cord blood banking, they offer other forms of autologous stem cell cryopreservation. StemOne is expanding to offer cord blood banking through more marketing associates and to support stem cell based therapies at medical centres. (Source).

The cost remains a major concern in India as also the putative benefits of the technology. However, If one has a history of genetic disorders in the family, onemight want to consider this technology that has changed millions of lives across the globe. Maybe, in time, we might be able to come up with schemes to subsidise the cost for poor and needy families and then Cord Blood Therapy will really have achieved a miracle ! !